It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed.
Several blood tests exist for Celiac disease.
Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease.
The most specific tests are tests for Celiac disease endomysial antibodies (EMA) and
tissue transglutaminase antibody (tTG) tests.
When either EMA or tTG are positive Celiac disease is very likely and usually the intestine biopsy is positive.
Seronegative Celiac, meaning the blood tests are negative but the biopsy is positive, may occur in up to 20% of Celiacs.
Newer assays for AGA antibodies for gluten that has undergone a chemical change
called deamidation appear to be more specific for Celiac disease (Gliadin II,
Inova) than the older gliadin tests.
The most distressing problem for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet respond to a gluten free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten.
Such stool testing has been performed in research labs and published in a few studies but are only recently available through the commercial lab, Enterolab.
Dr.
However, his unpublished data and the clinical experience of some of us who have used his test have
indicated the tests are very sensitive for signs of gluten sensitivity.
In the presence of symptoms, that reverse on a gluten-free diet,
abnormal stool antibody levels can be found in most people before blood tests or biopsies become
abnormal.
However, recent studies have demonstrated that some people with gluten sensitivity, especially relatives of Celiacs
with little or no symptoms, have changes from gluten injury to the intestine that can not be seen with normal microscope examination.
The special stains are known as immunohistochemistry stains.
When these lymphocytes are increased it is known as intraepithelial lymphocytosis or increased IELs and it is the earliest sign
of gluten induced injury or irritation.
When people who have these changes are
offered the option of a gluten-free diet they usually responded favorably.
What these studies suggest is that a "normal small intestine biopsy" may exclude
Celiac disease as defined by strict criteria but it is not a gold standard for detecting gluten sensitivity.
Another source of confusion is in the genetics of Celiac and gluten sensitivity.
Some use the absence of these two patterns
as a way of excluding the possibility of Celiac disease and the need for testing or
gluten-free diet.
Moreover, recent studies indicate other DQ
patterns may be associated with gluten sensitivity though unlikely to
predispose to classic Celiac disease.
Fine, based on his
experience with stool antibody test results.
According to his unpublished data, all the DQ types except DQ4 are associated with
a risk of intolerance to gluten.
Enterolab's stool testing for gliadin antibodies and tissue
transglutaminase antibodies, though not widely accepted, have gained favor in the lay
public's opinion as an option for determining sensitivity to gluten either despite negative blood tests and/or biopsies or in place of the more invasive tests.
Though the reports in the lay community
are overwhelmingly positive they have not been subjected to peer review in
the medical community pending Dr.
However, doctors open to
the broader problem of gluten
sensitivity are reporting these tests helpful in many patients suspected of gluten
intolerance.
The national Celiac organizations are uncertain about how to
comment on their application without published research though a recent article
in the British Medical Journal did show stool tests highly specific for Celiac.
Fine has publicly commented that his unpublished data demonstrates those with
abnormal stool tests indicating gluten sensitivity
overwhelmingly respond favorably to a gluten free diet with improvement of
symptoms and general quality of life.
This becomes especially difficult for those who do not meet strict criteria for Celiac disease yet may have abnormal tests and/or symptoms that respond to a gluten-free diet.
Consensus in the medical community on definitions and more research in this area is greatly needed.
Doctors either unfamiliar with the limitations of the tests as documented by Celiac research or who insist on the
strict criteria for Celiac being the only indication for recommending a gluten free
diet unfortunately may confuse or frustrate gluten sensitive individuals.
Many have their diagnosis missed, challenged, dismissed, or are misinformed.
In the meantime, Celiac disease and gluten sensitivity continue to be undiagnosed or misdiagnosed.
thefooddoc.
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The First Year: Celiac Disease and Living Gluten-Free: An Essential Guide for the Newly Diagnosed
celiac disease
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